Maternal Risks Associated with Pregnancy in Women with Advanced Maternal Age - a Review of 55,943 pregnancies

Introduction: The trend towards delayed motherhood has accelerated in developed countries over the last few decades. Advanced maternal age (AMA) is defined as age 35 years and older at the estimated date of delivery.Objective: The aim of this large retrospective cohort study is to assess for the association between AMA and adverse maternal outcomes after adjustment for confounding factors in maternal characteristics and in the obstetric history.Study Design: Mothers of 20 years and older, who delivered singleton babies in Malta and Gozo between 1st January 2000 and 31st December 2014 were studied. All data was derived from the National Obstetric Information System. Results: The study population included 55,943 singleton births. 12.2% (6,838) of mothers were between 35 – 39 years and 2.4% (1,325) were 40 years and older. Significant difference was found between maternal age and BMI (p < 0.0001), maternal smoking status (p < 0.0001), non-insulin dependent diabetes mellitus (p = 0.004), history of stillbirth (p < 0.0001), gestational diabetes (p < 0.0001), pregnancy – induced – hypertension (p = 0.008) and pre-eclampsia (p = 0.008). Significant difference was also found between maternal age and mode of delivery (p < 0.0001). Regression analysis revealed persistent significant differences between maternal age and different maternal outcomes.Conclusion: This study demonstrates that AMA in Malta significantly increases the risk for hypertension in pregnancy, gestational diabetes and caesarean delivery. Care providers need to be aware of these increased risks and adjust their obstetric management according to the individual to ensure optimal maternal outcomes.